This application seeks support for a pilot study to reduce the risk of type 2 diabetes in at-risk adults with a lifestyle change program provided by nurse practitioners (NPs) in primary care settings. Type 2 diabetes is one of the most rapidly increasing chronic illnesses worldwide and is associated with significant morbidity, mortality, personal suffering, and societal costs. The imperative for primary prevention of type 2 diabetes has increasingly been emphasized by health care organizations, governmental agencies, and policy initiatives. Several large clinical trials have convincingly established that lifestyle change programs can significantly prevent or delay the onset of type 2 diabetes in at-risk adults. Yet, questions remain regarding how to successfully implement these programs to the population at-large as the tested programs were intensive in terms of time and resources. Research is urgently needed to determine best practices to promote lifestyle change and prevent type 2 diabetes. Thus, this multi-phase pilot study has the following aims: 1. To modify a research-based lifestyle change program based on the Diabetes Prevention program collaboratively with NPs for implementation in primary care settings. 2. To evaluate the preliminary effects of the modified lifestyle change program provided by NPs to adults at-risk for type 2 diabetes on clinical outcomes [glucose tolerance test (GTT), insulin resistance (IR), body mass index (BMI), blood pressure (BP), lipid profile], behavioral outcomes (health promoting behaviors, diet and exercise behaviors), quality of life (QOL), and weight loss self- efficacy. 3. To explore the reach, adoption, implementation, and maintenance of a lifestyle change program delivered by NPs in primary care settings.